Overview

Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In 2019, a new coronavirus was identified as the cause of a disease outbreak that originated in China.

The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.

Public health groups, including the U.S. Centers for Disease Control and Prevention (CDC) and WHO, are monitoring the pandemic and posting updates on their websites. These groups have also issued recommendations for preventing and treating the illness.

Symptoms

Signs and symptoms of coronavirus disease 2019 (COVID-19) may appear two to 14 days after exposure. This time after exposure and before having symptoms is called the incubation period. You can still spread COVID-19 before you have symptoms, called presymptomatic. Common signs and symptoms can include:

• Fever
• Cough
• Tiredness

Early symptoms of COVID-19 may include a loss of taste or smell.

Other symptoms can include:

• Shortness of breath or difficulty breathing
• Muscle aches
• Chills
• Sore throat
• Runny nose
• Headache
• Chest pain
• Pink eye (conjunctivitis)
• Nausea
• Vomiting
• Diarrhea
• Rash

This list is not all inclusive. Children have similar symptoms to adults and generally have mild illness.

The severity of COVID-19 symptoms can range from very mild to severe. Some people may have only a few symptoms, and some people may have no symptoms at all, also called asymptomatic. Some people may experience worsened symptoms, such as worsened shortness of breath and pneumonia, about a week after symptoms start.

People who are older have a higher risk of serious illness from COVID-19, and the risk increases with age. People who have existing medical conditions also may have a higher risk of serious illness. Certain medical conditions that may increase the risk of serious illness from COVID-19 include:

• Serious heart diseases, such as heart failure, coronary artery disease or cardiomyopathy
• Cancer
• Chronic obstructive pulmonary disease (COPD)
• Type 1 or type 2 diabetes
• Overweight, obesity or severe obesity
• High blood pressure
• Smoking
• Chronic kidney disease
• Sickle cell disease or thalassemia
• Weakened immune system from solid organ transplants
• Pregnancy
• Asthma
• Chronic lung diseases such as cystic fibrosis or pulmonary fibrosis
• Liver disease
• Dementia
• Down syndrome
• Weakened immune system from bone marrow transplant, HIV or some medications
• Brain and nervous system conditions
• Substance use disorders

This list is not all inclusive. Other underlying medical conditions may increase your risk of serious illness from COVID-19.

When to see a doctor

If you have COVID-19 signs or symptoms or you've been in contact with someone diagnosed with COVID-19, contact your doctor or clinic right away for medical advice. Tell your health care team about your symptoms and possible exposure before you go to your appointment.

If you have emergency COVID-19 signs and symptoms, seek care immediately. Emergency signs and symptoms can include:

• Trouble breathing
• Persistent chest pain or pressure
• Inability to stay awake
• New confusion
• Pale, gray or blue-colored skin, lips or nail beds — depending on skin tone

This list isn't all inclusive. Let your doctor know if you are an older adult or have chronic medical conditions, such as heart disease or lung disease, as you may have a greater risk of becoming seriously ill with COVID-19. During the pandemic, it's important to make sure health care is available for those in greatest need.

Causes

Infection with the new coronavirus (severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2) causes coronavirus disease 2019 (COVID-19).

The virus that causes COVID-19 spreads easily among people, and more continues to be discovered over time about how it spreads. Data has shown that it spreads mainly from person to person among those in close contact (within about 6 feet, or 2 meters). The virus spreads by respiratory droplets released when someone with the virus coughs, sneezes, breathes, sings or talks. These droplets can be inhaled or land in the mouth, nose or eyes of a person nearby.

In some situations, the COVID-19 virus can spread by a person being exposed to small droplets or aerosols that stay in the air for several minutes or hours — called airborne transmission. It's not yet known how common it is for the virus to spread this way.

It can also spread if a person touches a surface or object with the virus on it and then touches his or her mouth, nose or eyes, but the risk is low.

The virus that causes COVID-19 can spread from someone who is infected but has no symptoms, also called asymptomatic. The virus that causes COVID-19 can also spread from someone who is infected but hasn�t developed symptoms yet, also called presymptomatic.

It�s possible to get reinfected with the virus that causes COVID-19, or to get COVID-19 twice or more, but this is uncommon.

Risk factors

Risk factors for COVID-19 appear to include:

• Close contact (within 6 feet, or 2 meters) with someone who has COVID-19
• Being coughed or sneezed on by an infected person

Complications

Although most people with COVID-19 have mild to moderate symptoms, the disease can cause severe medical complications and lead to death in some people. Older adults or people with existing medical conditions are at greater risk of becoming seriously ill with COVID-19.

Complications can include:

• Pneumonia and trouble breathing
• Organ failure in several organs
• Heart problems
• A severe lung condition that causes a low amount of oxygen to go through your bloodstream to your organs (acute respiratory distress syndrome)
• Blood clots
• Acute kidney injury
• Additional viral and bacterial infections

Prevention

The U.S. Food and Drug Administration (FDA) has given emergency use authorization to some COVID-19 vaccines in the U.S. The FDA has approved the Pfizer-BioNTech COVID-19 vaccine, now called Comirnaty, to prevent COVID-19 in people age 16 and older. A vaccine can prevent you from getting the COVID-19 virus or prevent you from becoming seriously ill if you get the COVID-19 virus. In addition, COVID-19 vaccination might offer better protection than getting sick with COVID-19. A recent study showed that unvaccinated people who already had COVID-19 are more than twice as likely as fully vaccinated people to get reinfected with COVID-19.

Also, if you are fully vaccinated, you can return to many activities you may not have been able to do because of the pandemic — including not wearing a mask or social distancing — except where required by a rule or law. However, if you are in an area with a high number of new COVID-19 cases in the last week, the CDC recommends wearing a mask indoors in public and outdoors in crowded areas or when you are in close contact with unvaccinated people. If you are fully vaccinated and have a condition or are taking medications that weaken your immune system, you may need to keep wearing a mask.

An additional dose of a COVID-19 vaccine is recommended for people who are fully vaccinated and might not have had a strong enough immune response. In contrast, a booster dose is recommended for people whose immune response weakened over time.

The CDC recommends additional doses and booster doses of COVID-19 vaccines in specific instances:

• Additional dose. The CDC recommends a third dose of an mRNA COVID-19 vaccine for some people with weakened immune systems, such as those who have had an organ transplant. People with weakened immune systems might not develop enough immunity after vaccination with two doses of an mRNA COVID-19 vaccine. An additional dose might improve their protection against COVID-19.

  The third dose should be given at least 28 days after a second dose of an mRNA COVID-19 vaccine. The additional dose should be the same brand as the other two mRNA COVID-19 vaccine doses you were given. If the brand given isn�t known, either brand of mRNA COVID-19 vaccine can be given as a third dose.

• Booster dose. The CDC recommends a booster dose of the Pfizer-BioNTech COVID-19 vaccine for people age 65 and older, residents in long-term care settings and people ages 50 to 64 who have underlying medical conditions, such as cancer, diabetes and heart disease. A booster dose of the Pfizer-BioNTech COVID-19 vaccine is also available to people ages 18 to 49 with underlying medical conditions and people ages 18 to 64 who have a job that puts them at increased risk of being exposed to COVID-19.

  The booster dose should be given at least 6 months after the second dose of the Pfizer-BioNTech COVID-19 vaccine.

There isn�t enough research to determine if people with weakened immune systems who got a Janssen/Johnson & Johnson COVID-19 vaccine also have an improved response after getting an additional dose of the same vaccine. The CDC also hasn�t made recommendations about booster doses for people who got the Moderna or Janssen/Johnson & Johnson COVID-19 vaccine.

If you haven�t had the COVID-19 vaccine, you can take many steps to reduce your risk of infection. WHO and CDC recommend following these precautions for avoiding exposure to the virus that causes COVID-19:

• Avoid close contact (within about 6 feet, or 2 meters) with anyone who is sick or has symptoms.
• Keep distance between yourself and others (within about 6 feet, or 2 meters). This is especially important if you have a higher risk of serious illness. Keep in mind some people may have COVID-19 and spread it to others, even if they don't have symptoms or don't know they have COVID-19.
• Avoid crowds and indoor places that have poor ventilation.
• Wash your hands often with soap and water for at least 20 seconds, or use an alcohol-based hand sanitizer that contains at least 60% alcohol.
• Wear a face mask in indoor public spaces and outdoors where there is a high risk of COVID-19 transmission, such as at a crowded event or large gathering. Further mask guidance differs depending on whether you are fully vaccinated or unvaccinated. Surgical masks may be used if available. N95 respirators should be reserved for health care providers.
• Cover your mouth and nose with your elbow or a tissue when you cough or sneeze. Throw away the used tissue. Wash your hands right away.
• Avoid touching your eyes, nose and mouth.
• Avoid sharing dishes, glasses, towels, bedding and other household items if you're sick.
• Clean and disinfect high-touch surfaces, such as doorknobs, light switches, electronics and counters, daily.
• Stay home from work, school and public areas if you're sick, unless you're going to get medical care. Avoid public transportation, taxis and ride-sharing if you're sick.

If you have a chronic medical condition and may have a higher risk of serious illness, check with your doctor about other ways to protect yourself.

Travel

If you're planning to travel, first check the CDC and WHO websites for updates and advice. Be prepared to wear a mask and use appropriate hand hygiene when in public. You may also want to talk with your doctor if you have health conditions that make you more susceptible to respiratory infections and complications.

Diagnosis

If you develop symptoms of coronavirus disease 2019 (COVID-19) or you've been exposed to the COVID-19 virus, contact your doctor. Also let your doctor know if you've had close contact with anyone who has been diagnosed with COVID-19.

Factors used to decide whether to test you for the virus that causes COVID-19 may differ depending on where you live. Depending on your location, you may need to be screened by your clinic to determine if testing is appropriate and available.

In the U.S., your doctor will determine whether to conduct tests for the virus that causes COVID-19 based on your signs and symptoms, as well as whether you have had close contact with someone diagnosed with COVID-19. Your doctor may also consider testing if you are at higher risk of serious illness or you are going to have a medical procedure. If you have had close contact with someone with COVID-19 but you've had COVID-19 in the past three months, you don�t need to be tested. If you�ve been fully vaccinated and you�ve had close contact with someone with COVID-19, get tested 3 to 5 days after you�ve had contact with them.

To test for the COVID-19 virus, a health care provider takes a sample from the nose (nasopharyngeal swab), throat (throat swab) or saliva. The samples are then sent to a lab for testing. If you're coughing up sputum, that may be sent for testing. The FDA has authorized at-home tests for the COVID-19 virus. These are available only with a doctor's prescription.

Treatment

Currently, only one medication has been approved to treat COVID-19. No cure is available for COVID-19. Antibiotics aren't effective against viral infections such as COVID-19. Researchers are testing a variety of possible treatments.

The FDA has approved the antiviral drug remdesivir (Veklury) to treat COVID-19 in hospitalized adults and children who are age 12 and older in the hospital.

The FDA has granted an emergency use authorization for the rheumatoid arthritis drug baricitinib (Olumiant) to treat COVID-19 in some cases. Baricitinib is a pill that seems to work against COVID-19 by reducing inflammation and having antiviral activity. The FDA states baricitinib may be used in people who are hospitalized with COVID-19 who are on mechanical ventilators or need supplemental oxygen.

Several monoclonal antibody medications are available. These include sotrovimab and a combination of two antibodies called casirivimab and imdevimab. These drugs are used to treat mild to moderate COVID-19 in people who have a higher risk of developing serious illness due to COVID-19. Treatment consists of a single intravenous infusion given in an outpatient setting. To be most effective, these medications need to be given soon after COVID-19 symptoms start and prior to hospitalization.

The FDA has also authorized the use of casirivimab and imdevimab as a treatment for people at higher risk of serious illness who have recently been exposed to the COVID-19 virus or who are at high risk of exposure. For example, people at high risk of exposure may include those living in nursing homes or prisons where others have recently been infected with the COVID-19 virus. This treatment is for people who aren't fully vaccinated, or who are fully vaccinated but have a weakened immune system.

The U.S. National Institutes of Health has recommended the corticosteroid dexamethasone for people hospitalized with severe COVID-19 who are on supplemental oxygen or need mechanical ventilation. Other corticosteroids, such as prednisone, methylprednisolone or hydrocortisone, may be used if dexamethasone isn't available.

The FDA has also granted emergency use authorization for convalescent plasma therapy with high antibody levels to treat COVID-19. Convalescent plasma is blood donated by people who've recovered from COVID-19. Convalescent plasma with high antibodies may be used to treat some hospitalized people ill with COVID-19 who are either early in their illness or who have weakened immune systems.

Many people with COVID-19 may have mild illness and can be treated with supportive care. Supportive care is aimed at relieving symptoms and may include:

• Pain relievers (ibuprofen or acetaminophen)
• Cough syrup or medication
• Rest
• Fluid intake

There is no evidence that ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs) need to be avoided.

If you have mild symptoms, your doctor may recommend that you recover at home. He or she may give you special instructions to monitor your symptoms and to avoid spreading the illness to others. You'll likely be asked to isolate yourself as much as possible from family and pets while you're sick, wear a mask when you're around people and pets, and use a separate bedroom and bathroom.

Your doctor will likely recommend that you stay in home isolation for a period of time except to get medical care. Your doctor will likely follow up with you regularly. Follow guidelines from your doctor and local health department about when you can end home isolation.

If you're very ill, you may need to be treated in the hospital.

Coping and support

It's common to feel fearful and anxious during the COVID-19 pandemic. You're probably worried that you or those you love will get sick. You may be concerned about taking care of yourself or others who are ill.

During this time, remember to take care of yourself and manage your stress.

• Eat healthy meals.
• Get enough sleep.
• Get physical activity as you're able to, such as using exercise or yoga videos. If you're healthy, go outside for a walk.
• Try relaxation exercises such as deep breathing, stretching and meditation.
• Avoid watching or reading too much news or spending too much time on social media.
• Connect with friends and family, such as with phone or video calls.
• Do activities you enjoy, such as reading a book or watching a funny movie.

If you're ill with COVID-19, it's especially important to:

• Get plenty of rest.
• Drink fluids.
• Let your doctor know right away if your symptoms worsen.

Having COVID-19 or caring for someone with the disease can cause stress and anxiety. If stress is affecting your daily life after several days, contact your doctor. He or she may suggest that you talk to a mental health professional.

Preparing for an appointment

During a pandemic, it's not always possible for everyone who is ill to see a doctor. You may start by seeing your primary care doctor or other health care provider. Or you may be referred immediately to a doctor trained in treating infectious diseases. If you think you have COVID-19, tell your doctor or clinic before going in. The doctor and medical team can then:

• Contact infection prevention and control and public health officials
• Prepare to move you to a room quickly
• Have a mask ready for you

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance. Make a list of:

• Your symptoms, including any that seem unrelated to the reason for your appointment
• Your recent travels, including any international travels
• Key personal information, including major stresses, recent life changes and family medical history
• All medications, vitamins or other supplements you take, including the doses
• Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you're given. Avoid bringing more than one or two people. Check before you go to the appointment, as your hospital or clinic may have visitor restrictions.

Some basic questions to ask your doctor include:

• How likely is it that COVID-19 is causing my symptoms?
• What are other possible causes for my symptoms?
• What tests do I need?
• What course of action do you recommend?
• Are there restrictions I need to follow?
• Should I see a specialist?

What to expect from your doctor

Your doctor is likely to ask you several questions, such as:

• When did your symptoms begin?
• Where have you traveled recently?
• Who have you been in close contact with?
• How severe are your symptoms?